The use of durvalumab and tremelimumab after atezolizumab and bevacizumab in patients with hepatocellular carcinoma: case report and literature review.

Abstract

Hepatocellular carcinoma (HCC) often presents at an advanced stage, limiting treatment options. Historically, systemic therapies like tyrosine kinase inhibitors and VEGF-targeted antibodies offered modest survival benefits. HCC's immunosuppressive microenvironment, driven by regulatory T cells, myeloid-derived suppressor cells, and immune checkpoint signaling, hinders effective therapy. Immune checkpoint inhibitors (ICPIs) have revolutionized HCC management by targeting these pathways. Atezolizumab and bevacizumab (Atezo/Bev) is the standard first-line therapy for unresectable HCC, but post-progression options are limited. We explore the potential of switching to durvalumab and tremelimumab (Durva/Treme) as a second-line strategy. Recently approved, Durva/Treme shows promise, yet data on sequential ICPI use remain scarce. This editorial highlights the rationale for this approach, leveraging distinct immune targets to overcome resistance. Preliminary evidence suggests durable responses are achievable, but robust clinical trials are needed to validate efficacy, optimize sequencing, and identify biomarkers. Durva/Treme's role as a second-line option could address the critical gap in HCC treatment, challenging the immunosuppressive tumor microenvironment. We advocate for bold innovation to improve outcomes in this complex disease, urging further research into ICPI rechallenge strategies to transform the therapeutic landscape for patients with unresectable HCC.